In CMS
Nov 19th, 2018
Medicare generally does not allow coding for two, same-day E/M office visits by the same physician (or any other physician of the same specialty from the same group practice). But with the release of the 2019 Physician Fee Schedule Final Rule, the Centers for Medicare & Medicaid Services (CMS) has indicated it may revise this ...
In CMS
Nov 14th, 2018
Another opioid pill mill gets busted by the Medicare Fraud Strike Force. A “pain management clinic” in Hialeah, Florida, owned by David Bosch and Tania Sanchez, which operated under the name East Medical Office Inc., unlawfully distributed thousands of pills of oxycodone, during the period of April 2017-May 2018. It was a cash-only clinic, which remained ...
In CMS
Nov 1st, 2018
Anthem paid a $16 million settlement resulting from a series of attacks in both 2014 and 2015 that had the potential to expose personal health information (PHI) of 79 million people.  Although they paid the $16 million settlement, Anthem does not admit to any wrong doing.  This represented the largest PHI breach in US history ...
In Billing
Oct 19th, 2018
A beginner’s guide to claims code editing logic. The U.S. healthcare system is highly complicated and extremely expensive. There are many layers between the provider of medical services and the payment for those services. This overly complex system leads to inefficiencies resulting in incorrectly paid claims and the need to spend even more time and ...
In Coding
Oct 12th, 2018
With the 2019 CPT® codebook still a few weeks away, we’re waiting to confirm an anticipated change: new guidelines that allow modifier 63 Procedure performed on infants less than 4 kgs with Medicine/Cardiovascular (90000-series) codes to described increased complexity of procedures performed on patients of less than 4kg. How to Use Modifier 63 When a surgeon ...